Otterbein at Granville
Organization Active NPI Skilled Nursing Facility · Granville, OH
NPI 1003974023 · NPPES record last updated Dec 27, 2022
Key facts
- NPI
- 1003974023
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 2424N (OH)
- Legal business name
- OTTERBEIN AT GRANVILLE
- Practice address
- 2158 Columbus Rd
Granville, OH 43023-1242 - Phone
- (740) 587-2840
- Fax
- (740) 321-0485
- NPI assigned
- Dec 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Douglas P Helman
- Title
- Executive Director
- Phone
- (740) 587-2840
Owners & managing parties with NPI records 3
-
Talya Greathouse, MD
Facilities with the same owner 26
Affiliated clinicians 5
-
Caryn Gorby, CNP
-
Prit Patel, MD
-
John M Weigand, MD
Medicare Care Compare: Nursing home
- Listed as
- Otterbein at Granville
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★★ 5 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare
- Ownership
- Non profit - Corporation
- Certified
- Jun 24, 2005
- Medicare certification status
- Active
- Certified beds
- 22 · 20.6 residents per day on average
- Chain
- Otterbein Seniorlife
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D1035835 | Otterbein at Granville | Certificate of waiver | Jan 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 366314
- Legal name
- OTTERBEIN AT GRANVILLE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF (Medicare) only
- Participating since
- Jun 24, 2005
- Last certification
- May 29, 2025
- Beds
- 22
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Otterbein SeniorLife
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 14, 1999 in OH
- Enrollment address
- 2158 Columbus Rd
Granville, OH 43023-1242 - Nursing home name
- OTTERBEIN AT GRANVILLE
- Affiliated entity
- OTTERBEIN SENIORLIFE
All disclosed owners & managing parties 33
| Name | Role | Since | Share |
|---|---|---|---|
| Becky Bayliff |
Operational/Managerial Control | Dec 1, 2021 | |
| Polaris Pharmacy Services of Ohio LLC |
Adp of the SNF | Dec 1, 2018 | |
| Jason E Miller |
Corporate Officer |
Dec 1, 2021 | |
| Greg Sharkey |
Managing Control - Governing Body |
Jan 1, 2021 | |
| Trustee of the SNF | Jan 1, 2021 | ||
| Heidi Glosser |
Operational/Managerial Control | Dec 1, 2021 | |
| Derik R Kroeze |
Operational/Managerial Control | Nov 13, 2017 | |
| Adp of the SNF | Nov 13, 2017 | ||
| Victoria Bartlett |
Operational/Managerial Control | Dec 1, 2021 | |
| Richard Johnston |
Managing Control - Governing Body |
May 1, 2017 | |
| Trustee of the SNF | May 1, 2017 | ||
| Christie Vargo |
Managing Control - Governing Body |
Jan 1, 2021 | |
| Trustee of the SNF | Jan 1, 2021 | ||
| William Brownson |
Corporate Director |
Dec 1, 2021 | |
| Operational/Managerial Control | Dec 1, 2021 | ||
| Jennifer Weekly |
Corporate Director |
Nov 9, 2004 | |
| Todd Ware |
Managing Control - Governing Body |
Dec 1, 2021 | |
| Trustee of the SNF | Dec 1, 2021 | ||
| Rita C Hawkins |
Corporate Officer |
Jan 16, 2006 | |
| Tomas Hazelbaker |
Operational/Managerial Control | Dec 1, 2021 | |
| Andy Crawford |
Managing Control - Governing Body |
Jan 1, 2020 | |
| Trustee of the SNF | Jan 1, 2020 | ||
| Talya R Greathouse |
Managing Control - Governing Body |
Jan 1, 2016 | |
| Trustee of the SNF | Jan 1, 2016 | ||
| Jonathan Hollister |
Operational/Managerial Control | Dec 1, 2021 | |
| Adp of the SNF | Dec 1, 2021 | ||
| Ralph Reed Fraley |
Operational/Managerial Control | Dec 1, 2021 | |
| Anne Peterson |
Managing Control - Governing Body |
Jan 1, 2023 | |
| Trustee of the SNF | Jan 1, 2023 | ||
| Otterbein LSC, LLC |
5% Or Greater Direct Ownership Interest | Feb 1, 2023 | 100% |
| Functional Pathways of Tennessee LLC |
Operational/Managerial Control | Dec 1, 2018 | |
| Adp of the SNF | Mar 25, 2025 | ||
| Jill Wilson |
Corporate Officer |
May 1, 2009 | |
| Connie Hawk |
Managing Control - Governing Body |
Jan 1, 2020 | |
| Trustee of the SNF | Jan 1, 2020 | ||
| Stephen Layman |
Managing Control - Governing Body |
Dec 1, 2021 | |
| Trustee of the SNF | Dec 1, 2021 | ||
| Otterbein Home |
5% Or Greater Indirect Ownership Interest | Dec 1, 2021 | 100% |
| Operational/Managerial Control | Dec 1, 2021 | ||
| Adp of the SNF | Dec 1, 2021 | ||
| James Christopher Green |
Corporate Officer |
Dec 1, 2021 | |
| Nancy Neely |
Managing Control - Governing Body |
Dec 1, 2021 | |
| Trustee of the SNF | Dec 1, 2021 | ||
| Robert Coleman |
Operational/Managerial Control | Dec 1, 2021 | |
| Dale Lewellen |
Managing Control - Governing Body |
Jan 1, 2025 | |
| Trustee of the SNF | Jan 1, 2025 | ||
| Daniel Burke |
Operational/Managerial Control | Dec 1, 2021 | |
| Lynn App |
Operational/Managerial Control | Dec 1, 2021 | |
| Steve Vonderhaar |
Operational/Managerial Control | Dec 1, 2021 | |
| Molly C Ingold |
Corporate Officer |
Jan 1, 2018 | |
| Corporate Director |
Jan 1, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050216000683 | OH | Part a Provider - Skilled Nursing Facility | 4183676224 | Practice locations: Granville, OH |
National Provider Directory
Networks
- OH PPO
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2424N | OH | Yes |
Addresses
Primary practice location
2158 Columbus Rd
Granville, OH 43023-1242
Mailing address
2158 Columbus Rd
Granville, OH 43023-1242
Phone (740) 587-2840
Other providers in Granville, OH
- Ohio CVS Stores LLC
- Orr Health & Chiropractic Clinc, Inc
- Orr Health & Chiropractic Clinic
- Orr Health & Chiropractic Clinic
- Orthopedic Specialists & Sports Medicine, Inc.
- Robert Scott Owen
- David O. Parker
- Prit Patel
- Radhika Patel
- Paul Johnson DMD LLC
All providers in Granville, OH · Skilled Nursing Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.